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Thorax Sep 1969The deformity of pectus excavatum is caused by a negative pressure in the anterior mediastinum sucking in the body of the sternum. This is usually due to the heart lying...
The deformity of pectus excavatum is caused by a negative pressure in the anterior mediastinum sucking in the body of the sternum. This is usually due to the heart lying on the left side, leaving the mediastinum empty so that the sternum and costal cartilages are sucked in to fill the empty space. The operation consists of excising the deformed cartilages, mobilizing the sternum, and suturing the pericardial sac into a central position which corrects the deformity.
Topics: Adolescent; Adult; Cartilage; Child; Funnel Chest; Heart Defects, Congenital; Humans; Male; Mediastinum; Pericardium; Pressure; Sternum
PubMed: 5348322
DOI: 10.1136/thx.24.5.557 -
American Journal of Transplantation :... Jan 2021Severe chest wall deformities are considered an absolute contraindication for lung transplantation. The significantly impaired chest compliance associated with pectus...
Severe chest wall deformities are considered an absolute contraindication for lung transplantation. The significantly impaired chest compliance associated with pectus excavatum is thought to result in a high risk of postoperative respiratory complications and significant morbidity and mortality. We herein report our pooled institutional experience consisting of 3 patients who underwent bilateral lung transplantation and simultaneous correction of a pectus excavatum. Two of the patients were children and 1 patient had severe asymmetric pectus. All patients received a size-reduced double lung transplant and the deformity was corrected by a Nuss or modified Ravitch procedure. The perioperative course was complicated by prolonged weaning requiring tracheostomy in 2 of the 3 patients. However, long-term results were good and all 3 patients are alive in excellent clinical condition 72, 60, and 12 months after the transplantation. This case series demonstrates that patients with severe chest wall deformities should not a priori be excluded from lung transplantation, and a combined approach is feasible for selected patients.
Topics: Child; Funnel Chest; Humans; Lung Transplantation; Postoperative Complications
PubMed: 32619074
DOI: 10.1111/ajt.16180 -
The Cochrane Database of Systematic... Oct 2014Pectus excavatum is characterized by a depression of the anterior chest wall (sternum and lower costal cartilages) and is the most frequently occurring chest wall... (Review)
Review
BACKGROUND
Pectus excavatum is characterized by a depression of the anterior chest wall (sternum and lower costal cartilages) and is the most frequently occurring chest wall deformity. The prevalence ranges from 6.28 to 12 cases per 1000 around the world. Generally pectus excavatum is present at birth or is identified after a few weeks or months; however, sometimes it becomes evident only at puberty. The consequence of the condition on a individual's life is variable, some live a normal life and others have physical and psychological symptoms such as: precordial pain after exercises; impairments of pulmonary and cardiac function; shyness and social isolation. For many years, sub-perichondrial resection of the costal cartilages, with or without transverse cuneiform osteotomy of the sternum and placement of a substernal support, called conventional surgery, was the most accepted option for surgical repair of these patients. From 1997 a new surgical repair called, minimally invasive surgery, became available. This less invasive surgical option consists of the retrosternal placement of a curved metal bar, without resections of the costal cartilages or sternum osteotomy, and is performed by videothoracoscopy. However, many aspects that relate to the benefits and harms of both techniques have not been defined.
OBJECTIVES
To evaluate the effectiveness and safety of the conventional surgery compared with minimally invasive surgery for treating people with pectus excavatum.
SEARCH METHODS
With the aim of increasing the sensitivity of the search strategy we used only terms related to the individual's condition (pectus excavatum); terms related to the interventions, outcomes and types of studies were not included. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase, LILACS, and ICTPR. Additionally we searched yet reference lists of articles and conference proceedings. All searches were done without language restriction.Date of the most recent searches: 14 January 2014.
SELECTION CRITERIA
We considered randomized or quasi-randomized controlled trials that compared traditional surgery with minimally invasive surgery for treating pectus excavatum.
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed the eligibility of the trials identified and agreed trial eligibility after a consensus meeting. The authors also assessed the risk of bias of the eligible trials.
MAIN RESULTS
Initially we located 4111 trials from the electronic searches and two further trials from other resources. All trials were added into reference management software and the duplicates were excluded, leaving 2517 studies. The titles and abstracts of these 2517 studies were independently analyzed by two authors and finally eight trials were selected for full text analysis, after which they were all excluded, as they did not fulfil the inclusion criteria.
AUTHORS' CONCLUSIONS
There is no evidence from randomized controlled trials to conclude what is the best surgical option to treat people with pectus excavatum.
Topics: Funnel Chest; Humans; Osteotomy; Randomized Controlled Trials as Topic; Thoracic Surgery, Video-Assisted
PubMed: 25352359
DOI: 10.1002/14651858.CD008889.pub2 -
Journal of Pediatric Surgery Dec 2021Pectus excavatum (PE) could be part of a genetic disorder, which then has implications regarding comorbidity, the surgical correction of PE, and reproductive choices.... (Review)
Review
BACKGROUND
Pectus excavatum (PE) could be part of a genetic disorder, which then has implications regarding comorbidity, the surgical correction of PE, and reproductive choices. However, referral of a patient presenting with PE for genetic analysis is often delayed because additional crucial clinical signs may be subtle or even missed in syndromic patients. We reviewed the literature to inventory known genetic disorders associated with PE and create a standardized protocol for clinical evaluation.
METHODS
A systematic literature search was performed in electronic databases. Genetic disorders were considered associated with PE if studies reported at least five cases with PE. Characteristics of each genetic disorder were extracted from the literature and the OMIM database in order to create a practical guide for the clinician.
RESULTS
After removal of duplicates from the initial search, 1632 citations remained. Eventually, we included 119 full text articles, representing 20 different genetic disorders. Relevant characteristics and important clinical signs of each genetic disorder were summarized providing a standardized protocol in the form of a scoring list. The most important clinical sign was a positive family history for PE and/or congenital heart defect.
CONCLUSIONS
Twenty unique genetic disorders have been found associated with PE. We have created a scoring list for the clinician that systematically evaluates crucial clinical signs, thereby facilitating decision making for referral to a clinical geneticist.
Topics: Comorbidity; Funnel Chest; Heart Defects, Congenital; Humans; Mass Screening; Physicians
PubMed: 34039477
DOI: 10.1016/j.jpedsurg.2021.04.016 -
Acta Ortopedica Brasileira 2021Pectus excavatum is a deformity that affects aesthetics and causes emotional disorders. Surgical correction is well established, but conservative treatment is less...
OBJECTIVE
Pectus excavatum is a deformity that affects aesthetics and causes emotional disorders. Surgical correction is well established, but conservative treatment is less common. We investigated the long-term results of using a brace and performing specific physical exercises to treat localized pectus excavatum, a type of deformity in which the depressed area is restricted to the midline region along the nipple line.
METHODS
We selected 115 patients (mean age 12.8 years), with a minimum follow-up of 36 months, who were evaluated more than one year after the end of treatment and skeletal maturity. Results were correlated with deformity flexibility, severity, regular use of the device, and performance of specific exercises. The chi-square (χ) and the Cochran-Mantel-Haenszel tests were used for statistical analysis.
RESULTS
Treatment was successful in 58% of patients, however, when exercises were performed and the brace was used regularly by patients with flexible deformities, the rate increased to 83% (p = 0.005). Severity and adherence to treatment greatly impacted successful treatment (p = 0.009 and < 0.001, respectively).
CONCLUSION
The proposed treatment method was effective for correction or partial correction of the deformity in motivated patients followed up until skeletal maturity, especially when started early in milder and more flexible deformities.
PubMed: 34290561
DOI: 10.1590/1413-785220212903241550 -
British Medical Journal Aug 1955
Topics: Congenital Abnormalities; Funnel Chest; Thorax
PubMed: 13240106
DOI: 10.1136/bmj.2.4935.362-a -
Turkish Journal of Medical Sciences Jun 2017Pectus excavatum and pectus carinatum are the most commonly seen anterior chest wall deformities. Recent studies reveal that minimal invasive repair of pectus...
BACKGROUND/AIM
Pectus excavatum and pectus carinatum are the most commonly seen anterior chest wall deformities. Recent studies reveal that minimal invasive repair of pectus deformities improves the quality of life. Our aim is to assess the psychosocial functioning and sociodemographic characteristics of pediatric patients with pectus deformities and evaluate the differences between patients operated on with minimal invasive repair techniques and nonoperated patients.
MATERIALS AND METHODS
Thirty-two patients with pectus deformities who were operated on 6 months or more before and 31 nonoperated patients participated in the study. The Children's Depression Inventory, Piers-Harris Children's Self-Concept Scale, Capa Social Phobia Scale for Children and Adolescents, Strengths and Difficulties Questionnaire - Self-Report Version (SDQ-SR), and State-Trait Anxiety Inventory for Children - Trait Version were completed by the patients. The SDQ-Parent Report Version (SDQ-PR) was completed by their parents.
RESULTS
There were no statistically significant differences between operated and nonoperated patient groups in terms of total scores on the psychiatric rating scales. Prosocial behavior subscale scores in SDQ-SR (P = 0.013) and SDQ-PR (P = 0.019) were lower in the operated group.
CONCLUSION
Prosocial behavior levels were lower in the operated group. Further exploration of the psychosocial profile of pediatric patients with pectus deformities would better elucidate their needs in the course of their socioemotional development.
Topics: Adolescent; Adult; Child; Cross-Sectional Studies; Depression; Funnel Chest; Humans; Middle Aged; Parents; Pectus Carinatum; Social Behavior
PubMed: 28618768
DOI: 10.3906/sag-1511-66 -
Journal of the American Heart... Apr 2022
Topics: Exercise Test; Funnel Chest; Humans; Retrospective Studies; Treatment Outcome
PubMed: 35377161
DOI: 10.1161/JAHA.122.025273 -
The Pan African Medical Journal 2021
PubMed: 34367426
DOI: 10.11604/pamj.2021.38.347.28813 -
Frontiers in Surgery 2023The conventional technique for pectus excavatum repair was pushing up the depressed chest wall by turning over the convexity of the bent pectus bar. We developed a new...
INTRODUCTION
The conventional technique for pectus excavatum repair was pushing up the depressed chest wall by turning over the convexity of the bent pectus bar. We developed a new concept in which a total crane lift was used as the source of power to elevate the depressed sternum without using pectus bar leverage. This study aims to verify the efficacy of exclusively crane-powered pectus excavatum repair in recent years.
METHODS
Among the 3622 pectus deformity repairs since 1999, 691 cases repaired with the total crane power between 2017 and 2022 were enrolled. The mean age was 12.0 years (3-45). The operative technique involved wire/screw crane elevation of the sternum, the entire chest wall remodeling with the cross or parallel bars, the bridge/claw bar fixations, and other adjunctive techniques. Outcome analysis included morphological variations, patterns of pectus bar placement, and complication rates.
RESULTS
The crane technique and pectoscopy (100%) were used. The bar placements were parallel (22.0%) and cross-bar (47.5%). The bar fixations were the claw fixators for a single bar (30.5%) and the bridge plates for multiple bars (69.5%). The flare-buster and magic strings were liberally used. No serious complications or catastrophic events occurred, but minor complications occurred in 16.9%: pneumothorax in 7.4% (51), pleural effusion in 1.6% (11), and wound problems in 0.4% (3). There was no case of bar displacement.
DISCUSSION
The crane-powered pectus excavatum repair showed excellent results with minimal complications and no bar displacement. This innovative approach, part of the NeoPectus surgery, represents a significant advancement in correcting pectus excavatum deformities by utilizing a crane machine to elevate the chest wall.
PubMed: 38192491
DOI: 10.3389/fsurg.2023.1267009